Provider Demographics
NPI:1801161260
Name:HOLT, IRENE MICHELE
Entity type:Individual
Prefix:MRS
First Name:IRENE
Middle Name:MICHELE
Last Name:HOLT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48052 S 356 RD
Mailing Address - Street 2:
Mailing Address - City:PAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74058-5123
Mailing Address - Country:US
Mailing Address - Phone:918-223-5840
Mailing Address - Fax:
Practice Address - Street 1:48052 S 356 RD
Practice Address - Street 2:
Practice Address - City:PAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74058-5123
Practice Address - Country:US
Practice Address - Phone:918-223-5840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker